Speaking Truth to Power

Monheit, Alan C., Inquiry

No one said that the process of legislating health reform would be pretty, but neither were we warned that it would become downright ugly. The spate of "town hall" meetings this past summer has demonstrated how blatant mischaracterizations of reform proposals, distortions of truth, ideological posturing, and unruly shouting tactics can be used to undermine any hope of an informed and civil dialogue over the content of health reform. In the words of the late New York Times columnist William Satire, the "nattering nabobs of negativism" in several instances caused such conversations to be quickly curtailed or cancelled, or put politicians from both parties in the unenviable position of trying to be heard above the madding crowd. Such incivility attained new heights during President Obama's Sept. 9 speech on health reform when Rep. Joseph Wilson (RSC) called the president a "liar" regarding a statement over the exclusion of illegal immigrants in the president's reform proposal.

After last year's contentious presidential campaign, and the post-election hope for a bipartisan dialogue over health reform, it is disheartening to see that the tactics of distortion continue to dominate our political landscape. Conservative ideologues in the political and communications arenas are still stooping to the strategies of misinformation and exaggeration in an effort to maintain the health care status quo and ensure the failure of reform to enhance their chances of regaining political power--and they are doing so without any real attempt to propose an alternative vision. Indeed, as a number of leading conservatives have observed, the invective over health reform has detracted from a serious debate over the policy issues inherent in the proposals of the administration and congressional Democrats (Rutenberg and Harris 2009).

A number of reasons have been offered for the raucous reception that has greeted efforts to create a health reform dialogue. Observers have cited frustration over the general uncertainty of our economic prospects; the slow pace of recovery and dismal performance of labor markets; the general and continuing mistrust of government now exacerbated by the sizable infusion of stimulus and Troubled Assets Relief Program (TARP) monies; the distorted reward system that still dominates our financial sector; and the growing size of the government deficit and national debt. However, departures from truth and exaggerated claims made by extremists on the right have also added fuel to the fire by threatening that reform will lead to a government "takeover" of health care. In doing so, it has been claimed, faceless bureaucrats will dictate one's choice of health plan, engage in explicit rationing of care, use "death panels" to determine who among our elders will live or die, pay for care by directly withdrawing funds from individual bank accounts, and use tax dollars to provide health benefits to illegal immigrants and to finance abortions.

This poorly played political drama has already had at least one unfortunate consequence. Specifically, a very reasonable proposal to finance consultations between bereaved families and physicians as to how best to care for terminally ill patients was given the "death panel" moniker by former Alaska governor and vice-presidential candidate Sarah Palin and endorsed by the prominent Republican senator Charles Grassley. The senator, one of six key members of the Senate Finance Committee seeking to forge a bipartisan compromise over reform, feared that the provision would result in "pulling the plug on grandma" and had it excised from the Senate's reform bill. This cut was made despite the fact that the provision for financing such counseling had received bipartisan sponsorship in the House, that last year Congress approved legislation requiring physicians to discuss living wills and advanced directives with Medicare enrollees, and that 1992 saw federal legislation requiring hospitals and nursing homes to assist patients with these documents (Associated Press 2009). …

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